| NPI | 1053652149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11687) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP 5430) |
| 101YP2500X Counselor, Professional (Licence: NC 14163) | |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2025-05-07 |